Características del alcoholismo. Policlínico Carlos Manuel Portuondo Municipio Marianao, 2012- 2013 / Features alcoholism. Carlos Manuel Portuondo Polyclinic Marianao Municipality, 2012- 2013

Se realizó un estudio descriptivo transversal en el consultorio 15 del médico de familia perteneciente al Policlínico Docente Carlos Manuel Portuondo del Muicipio Marianao, Provincia La Habana, en el período comprendido entre noviembre de 2012 y enero de 2013, con el objetivo de caracterizar a los pacientes alcohólicos de la comunidad. El universo de estudio lo constituyeron los 40 pacientes con diagnóstico de alcoholismo. La fuente primaria de datos fue: la historia clínica, los datos obtenidos se llevaron a una encuesta que se aplicó y confeccionó según objetivos propuestos, que incluyó las variables: grupo de edad, sexo, situación laboral, escolaridad, estado civil, comportamiento según el consumo de alcohol, factores de riesgo, enfermedades mentales asociadas y complicaciones. Los datos se procesaron de forma computarizada. Los resultados se ilustraron en tablas y texto, se utilizaron las medidas estadísticas de frecuencia y porcentaje. Se reportan como resultados más importantes que el 25 por ciento tenían entre 30 y 39 años, 75 por ciento eran hombres, 52.5 por ciento tenían pareja, 67.5 por ciento eran obreros, 65 por ciento tenían un nivel escolar de secundaria, 80 por ciento fueron bebedores abusivos, en 80 por ciento los factores de riesgo fueron social, 27.5 por ciento padecían de trastornos depresivos y en el 100 por ciento presentaron complicaciones económicas. Se concluyó que: predominaron los bebedores abusivos menores de 40 años con pareja que laboraban como obreros y con nivel secundario; el alcoholismo se debió a problemas sociales en sujetos con síntomas depresivos y produjo complicaciones económicas.Palabras clave: alcoholismo, bebedor abusivo, dependencia del alcohol(AU)

A cross-sectional descriptive study was conducted in the office 15 family physicians belonging to Teaching Polyclinic Carlos Manuel Portuondo Township Marianao, Havana Province, in the period between November 2012 and January 2013, with the aim of characterizing alcoholic patients in the community. The universe of study was 40 patients with a diagnosis of alcoholism. The primary source of data: clinical history, data from a survey carried and drew up was applied according to its objectives, which included the variables: age group, sex, employment status, education, marital status, behavior under alcohol consumption, risk factors, and complications associated with mental illness. The data were processed by computer. The results are illustrated in tables and text, statistical measures of frequency and percentage were used. Are reported as the most important results that 25 percent were between 30 and 39 years, 75 percent were men, 52.5 percent had a partner, 67.5 percent were workers, 65 percent had a high school level, 80 percent were abusive drinkers, 80 percent risk factors were social, 27.5 percent suffered from depressive disorders and 100 percent had money problems. They concluded that abusive drinkers predominated under 40 with a couple who worked as laborers and secondary level; alcoholism was due to social problems in subjects with depressive symptoms and economic complications occurred(AU)

Funcionamento Diferencial do Item no Alcohol Use Disorders Identification Test / Differential Item Functioning in the Alcohol Use Disorders Identification Test / Funcionamiento Diferencial del Ítem en el Alcohol Use Disorders Identification Test

O objetivo do presente estudo foi investigar a presença de Funcionamento Diferencial do Item (DIF) para o sexo nos itens de uma popular medida de rastreio para a dependência do álcool, o Alcohol Use Disorders Identification Test (AUDIT). Os participantes foram 254 estudantes universitários. As análises de DIF foram realizadas a partir do modelo Partial Credit. Três itens não apresentaram ajuste adequado ao modelo, enquanto outro item apresentou um viés de grande magnitude para o sexo feminino. Especificamente, o itemAUDIT-6 mostrou ser, de fato, um aspecto do beber com maior severidade para indivíduos do sexo feminino do que para aqueles dosexo masculino. Recomenda-se cautela na utilização de escores brutos a partir dos 10 itens originais do instrumento e a exclusão doitem AUDIT-6 ou sua reformulação para a aplicação em indivíduos do sexo feminino.

The aim of the present study was to investigate Differential Item Functioning (DIF) for sex in a popular screening measure of alcohol dependence, the Alcohol Use Disorders Identification Test (AUDIT). Participants were 254 undergraduate students. Raschanalysis-based DIF procedures were employed to evaluate the possibility of sex bias in the AUDIT items. Results showed three items with inadequate fit to the unidimensional Partial Credit model and one item with a large bias against women. Specifically, item AUDIT-6 showed a larger difficulty estimate for women, suggesting a more severe aspect of drinking behavior for these individuals. Recommendations are made with regard to using raw scores based on the sum of the 10 AUDIT items. Dropping out or reformulating the AUDIT-6 item to accommodate sex differences and to reduce errors of individual ability (severity) estimates is strongly advised.

El objetivo del presente estudio fue investigar la presencia de Funcionamiento Diferencial del Ítem (DIF) para el sexo en los ítems de una popular medida de rastreo para la dependencia del alcohol, el Alcohol Use Disorders Identification Test (AUDIT). Participaron 254 estudiantes universitarios. Los análisis de DIF fueron realizados a partir del modelo Partial Credit. Tres ítems no presentaron ajusteade cuado al modelo, mientras otro ítem mostró una tendencia de gran magnitud para el sexo femenino. Específicamente, el ítem AUDIT-6 mostró ser, de hecho, un aspecto del beber con mayor severidad para individuos del sexo femenino que para aquellos del sexo masculino. Se recomienda precaución en el uso de escores brutos a partir de los 10 ítems originales del instrumento y la exclusióndel ítem AUDIT-6 o su reformulación para la aplicación en individuos del sexo femenino.

Funcionamento Diferencial do Item no Alcohol Use Disorders Identification Test / Differential Item Functioning in the Alcohol Use Disorders Identification Test / Funcionamiento Diferencial del Ítem en el Alcohol Use Disorders Identification Test

O objetivo do presente estudo foi investigar a presença de Funcionamento Diferencial do Item (DIF) para o sexo nos itens de uma popular medida de rastreio para a dependência do álcool, o Alcohol Use Disorders Identification Test (AUDIT). Os participantes foram 254 estudantes universitários. As análises de DIF foram realizadas a partir do modelo Partial Credit. Três itens não apresentaram ajuste adequado ao modelo, enquanto outro item apresentou um viés de grande magnitude para o sexo feminino. Especificamente, o itemAUDIT-6 mostrou ser, de fato, um aspecto do beber com maior severidade para indivíduos do sexo feminino do que para aqueles dosexo masculino. Recomenda-se cautela na utilização de escores brutos a partir dos 10 itens originais do instrumento e a exclusão doitem AUDIT-6 ou sua reformulação para a aplicação em indivíduos do sexo feminino.(AU)

The aim of the present study was to investigate Differential Item Functioning (DIF) for sex in a popular screening measure of alcohol dependence, the Alcohol Use Disorders Identification Test (AUDIT). Participants were 254 undergraduate students. Raschanalysis-based DIF procedures were employed to evaluate the possibility of sex bias in the AUDIT items. Results showed three items with inadequate fit to the unidimensional Partial Credit model and one item with a large bias against women. Specifically, item AUDIT-6 showed a larger difficulty estimate for women, suggesting a more severe aspect of drinking behavior for these individuals. Recommendations are made with regard to using raw scores based on the sum of the 10 AUDIT items. Dropping out or reformulating the AUDIT-6 item to accommodate sex differences and to reduce errors of individual ability (severity) estimates is strongly advised.(AU)

El objetivo del presente estudio fue investigar la presencia de Funcionamiento Diferencial del Ítem (DIF) para el sexo en los ítems de una popular medida de rastreo para la dependencia del alcohol, el Alcohol Use Disorders Identification Test (AUDIT). Participaron 254 estudiantes universitarios. Los análisis de DIF fueron realizados a partir del modelo Partial Credit. Tres ítems no presentaron ajusteade cuado al modelo, mientras otro ítem mostró una tendencia de gran magnitud para el sexo femenino. Específicamente, el ítem AUDIT-6 mostró ser, de hecho, un aspecto del beber con mayor severidad para individuos del sexo femenino que para aquellos del sexo masculino. Se recomienda precaución en el uso de escores brutos a partir de los 10 ítems originales del instrumento y la exclusióndel ítem AUDIT-6 o su reformulación para la aplicación en individuos del sexo femenino.(AU)

Evidências de validade convergente do Millon Clinical Multiaxial Inventory-III / Evidencias de validad convergente del Millon Clinical Multiaxial Inventory-III / Evidences of convergent validity of Millon Clinical Multiaxial Inventory-III

Este estudo tem como objetivo verificar características de evidências de validade e sensibilidade do Millon Clinical Multiaxial Inventory-III (MCMI-III) em identificar traços patológicos em pessoas com necessidade de tratamento psicológico e/ou psiquiátrico usando o questionário de saúde geral de Goldberg (QSG) como instrumento de validade convergente. Foram avaliados 703 participantes com idades de 18 a 85 anos, dos sexos feminino e masculino, residentes e domiciliados em cidades brasileiras, representando todas as regiões do país. Os participantes foram divididos posteriormente em dois grupos (G1 e G2). Os resultados demonstraram que o grupo G1 (pessoas em tratamento) apresentou diferenças significativas entre as médias com relação ao grupo G2 (pessoas que não realizam tratamento). Por meio do QSG, resultados apontaram a relação com os escores do MCMI-III, contudo ainda são necessários estudos posteriores para confirmação dos resultados, além do estabelecimento de padrões normativos para a amostra brasileira.(AU)

This study aims to determine the characteristics of evidence of validity and sensitivity of the Millon Clinical Multiaxial Inventory III in identifying pathological traits in people needing psychological or psychiatric treatment using the Goldberg General Health Questionnaire (GHQ) as an instrument for convergent validity. We evaluated 703 male and female participants aged 18 to 85 years old, resident in various Brazilian cities. Participants were divided in two groups: G1 and G2. The results showed significant differences between means of G1 and G2. Through the GHQ administration, results showed a relationship between the scores of the two instruments. However, further studies are needed to establish normative standards for the Brazilian sample.(AU)

El presente estudio tiene como objetivo determinar la validad y sensibilidad del Millon Clinical Multiaxial Inventory III en la identificación de rasgos patológicos de las personas que necesitan tratamiento para trastornos psicológico y/o psiquiátrico utilizando el cuestionario de salud general de Goldberg (CSG) como medio de validez convergente. Se evaluaron 703 sujetos de entre 18 y 85 años, hombres y mujeres, residentes en las ciudades brasileñas. Los participantes fueron divididos en grupos G1 y G2. Los resultados mostraron diferencias significativas entre las medias de los grupos G1 y G2. A través de la administración del CSG se observa una relación entre las puntuaciones de los dos instrumentos. Sin embargo, se necesitan más estudios para establecer criterios normativos para la muestra brasileña.(AU)

Evidências de validade convergente do Millon Clinical Multiaxial Inventory-III / Evidences of convergent validity of Millon Clinical Multiaxial Inventory-III / Evidencias de validad convergente del Millon Clinical Multiaxial Inventory-III

Este estudo tem como objetivo verificar características de evidências de validade e sensibilidade do Millon Clinical Multiaxial Inventory-III (MCMI-III) em identificar traços patológicos em pessoas com necessidade de tratamento psicológico e/ou psiquiátrico usando o questionário de saúde geral de Goldberg (QSG) como instrumento de validade convergente. Foram avaliados 703 participantes com idades de 18 a 85 anos, dos sexos feminino e masculino, residentes e domiciliados em cidades brasileiras, representando todas as regiões do país. Os participantes foram divididos posteriormente em dois grupos (G1 e G2). Os resultados demonstraram que o grupo G1 (pessoas em tratamento) apresentou diferenças significativas entre as médias com relação ao grupo G2 (pessoas que não realizam tratamento). Por meio do QSG, resultados apontaram a relação com os escores do MCMI-III, contudo ainda são necessários estudos posteriores para confirmação dos resultados, além do estabelecimento de padrões normativos para a amostra brasileira.

This study aims to determine the characteristics of evidence of validity and sensitivity of the Millon Clinical Multiaxial Inventory III in identifying pathological traits in people needing psychological or psychiatric treatment using the Goldberg General Health Questionnaire (GHQ) as an instrument for convergent validity. We evaluated 703 male and female participants aged 18 to 85 years old, resident in various Brazilian cities. Participants were divided in two groups: G1 and G2. The results showed significant differences between means of G1 and G2. Through the GHQ administration, results showed a relationship between the scores of the two instruments. However, further studies are needed to establish normative standards for the Brazilian sample.

El presente estudio tiene como objetivo determinar la validad y sensibilidad del Millon Clinical Multiaxial Inventory III en la identificación de rasgos patológicos de las personas que necesitan tratamiento para trastornos psicológico y/o psiquiátrico utilizando el cuestionario de salud general de Goldberg (CSG) como medio de validez convergente. Se evaluaron 703 sujetos de entre 18 y 85 años, hombres y mujeres, residentes en las ciudades brasileñas. Los participantes fueron divididos en grupos G1 y G2. Los resultados mostraron diferencias significativas entre las medias de los grupos G1 y G2. A través de la administración del CSG se observa una relación entre las puntuaciones de los dos instrumentos. Sin embargo, se necesitan más estudios para establecer criterios normativos para la muestra brasileña.

Implicações dos modelos de atenção à dependência de álcool e outras drogas na rede básica em saúde / Implications of models of care for alcohol dependence and other drugs in primary health / Implicaciones para los modelos de atención a la dependencia de alcohol y otras drogas en la salud primaria

A situação da dependência de substâncias psicoativas tem se caracterizado como um grave problema no âmbito da saúde pública brasileira e mundial, requisitando das ciências e dos serviços de atenção estudos e ações sustentadas em conhecimento especializado, que dêem conta da complexidade da situação. No cenário atual da saúde existem diversos modelos de análise à dependência, sustentados em diferentes perspectivas epistemológicas, teórico e metodológicas, formando uma miscelânea de propostas. O presente artigo, baseado em pesquisa qualitativa realizada em um município de médio porte de Santa Catarina, objetiva descrever as implicações dos atuais modelos de análise e atenção da dependência de álcool e outras drogas nos serviços de saúde básica. Verificou-se que as concepções sobre a drogadição ainda estão sustentadas em modelos de análise dicotômicos e deterministas, em contradição com os princípios do SUS. Constatou-se também a falta da capacitação das equipes de Estratégia da Saúde da Família para lidarem com a problemática da dependência de álcool e outras drogas...

The situation of psychoactive substances has been characterized as a serious problem in Brazil’s public health and global requestingng of the sciences and healthcare services researches and sustained actions on specialized knowledge, that reveal the complexity of the situation. In the current scenario there are several health care models dependence, supported in different epistemological, theoretical and methodological, forming a patchwork of proposals. However, research has shown the low effectiveness of different treatment models. This article, based on qualitative research conducted in a medium-sized city of Santa Catarina, aims to describe the implications of current patterns of dependence analysis of alcohol and other drugs in primary health care. It was found that the concepts of dependency are still held on analysis dichotomous and deterministic, in contradiction with the principles of SUS and contacted the lack of training of staff to deal with the problem of alcohol dependence and other drugs...

La situación de las sustancias psicoactivas se ha caracterizado como un problema grave en la salud pública brasileña y mundial ordenamiento de las ciencias y la investigación de servicios de salud y acciones sostenidas en el conocimiento especializado, que tengan en cuenta la complejidad de la situación. En el escenario actual de la salud hay varios modelos de análisis a la dependencia, sostenido en diferentes epistemológicos, teóricos y metodológicos, formando un mosaico de propuestas. Este artículo, basado en una investigación cualitativa desarrollada en un municipio de tamaño mediano de Santa Catarina, tiene como objetivo describir las implicaciones de los modelos actuales de análisis y la atención en la dependencia de alcohol y otras drogas en los servicios básicos de salud. Se encontró que los puntos de vista sobre la adicción a las drogas sigue siendo celebrada el análisis dicotómicos y determinista, en contradicción con los principios de la NHS. También fue una falta de formación de los equipos de la Estrategia de Salud de la Familia para hacer frente al problema de la adicción al alcohol y otras drogas...

Caracterización del nivel de dependencia al alcohol entre habitantes de la Ciudad de México

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Summary: The dynamic and scope of the consumption of alcoholic beverages, in Mexico, have been known by household surveys, since the last third of the last century. Nowadays those surveys describe alcohol use as one of the main public health tasks nationwide, due not only to its consequences but also to the damage on the different areas of individual's everyday life. A number of indicators have been highlighted by the first survey on 1988, such as teetotalism rates, the alcohol consumers proportion, age of first use, and problems associated with alcohol consumption. As a public health problem, alcohol consumption represents high costs to health institutions because of the problems related to the consumption. So, it requires undertaking certain actions that would be deal with this problem on primary and structural attention, as well as in the individual susceptibility as prevention, or attention levels, diagnosis and treatment. All actions to face this problem are practically impossible in the absence of instruments to establish differential diagnosis between heavy drinking and alcohol dependence. Along the study of alcoholism, have been distinguished two issues to establish differential diagnosis. First is a traditional version of dependence diagnosis by DSM criterions, defined as disadaptative pattern of alcohol consumption that produces significant malaise, expressed trough one year long. The second diagnosis issue quantifies the individual differences of physical, psychological and social damage degrees, caused by the alcohol consumption. From this, appears the motion of Multiple Alcoholism Syndrome. From this last point of view, The Alcohol Use Inventary by Skinner, Horn and Wanberg (1983), is compose by 147 items self administrated, clusted in 24 scales. Time latter, as of many researches done by this research group, aroused The Multiple-syndrome Alcohol Model as The Alcohol Use Inventary simplified version, used as a useful differential diagnosis questionnaire in alcoholics. There for, last version has been done many researches that agree on characterize the alcohol use inventory as screening questionnaire useful to detect problematic drinking to implement primary intervention. Those authors suggest the use of this questionnaire at different stages and populations, with different cut points. Antecedent's use of the questionnaire in Mexico, by Ayala et al., made the adapted version, however, researches seems to be not enough to know the validity of diagnostic instruments on ethanol dependence. The Alcohol Dependence Scale (ADS) consider the dependence as a continuum of four levels, depending on the damage degree associated with alcohol consumption, on the different areas of physical, intellectual, social and psychiatric functioning. In the questionnaire 1 is the minimum cut point for dependence diagnostic and 48 as the highest point, this rank lets differentiate with respect to low dependence, moderate dependence, substantial dependence and severe dependence. This article pretends to diffuse the EDS's validity on inhabitants in Mexico City. As methodology, a case design and 1:1 paired controls were used by age and marital status. Through a not intentioned sampling by quotas were selected 240 men of 18 to 50 years old. The cases group was integrated by 120 individuals that voluntarily sought treatment at the Center of Assistance for the Alcoholic and Relatives (CAAF) from June, 1998 to June, 2000. All cases comply with DSM-IV alcohol dependence criterion; they reported the last consumption at one month before the beginning of the research and with basic school as scholar level. In the control group were 120 volunteers that request treatment to CAAF from June, 1998 to June, 2000. They did not comply with alcohol dependence criterion. As gold standard, was considered the DSM-IV criteria to sensibility, specificity and predictive values; the factorial structure and internal consistency of the scale are indicated. Socio-demographic data indicated 34 years old as sample average, just over the half had a partner at the time of the study; the predominant education level was secondary school (35%). In the cases the 86% covered 6 to 7 criteria for ethanol dependence in the DSM-IV; the predominant dependence level was moderate at 37%, while 53% of the control group had no evidence of dependence. The heterogeneity test showed significant statistics differences on dependence levels in cases and controls (t=23, df=238 and p=0.00). The ADS displays overall internal consistency of 0.96, based on the Cronbach Reliability Coefficient, a higher level of consistency than that reported in previous studies. With a factorial analysis by varimax rotation and maximum likelihood extraction, revealed the presence of three factors with 56.5% of variance explained: intoxication (48.3%), abstinence (5.6%) and delirium tremens. In the application manual, the authors specify 13/14 as values to use the DAS as a diagnosis questionnaire, and 9 for a screening instrument. While other authors suggest less cut points 13/14 to 2/3 to reduce the false-negative; however, on Mexico City inhabitants, such cut points were inappropriate. The most suitable cut point to detect a significant dependence on clinical was at 8 points, with 96% sensitivity, 98% specificity and a 94% likelihood of making correct diagnoses. These findings show that DAS is a suitable screening instrument for using on Mexico City inhabitants. We suggest including items to evaluate social area or any other scale to complement the ADS.